PNHP

We need to provide Medicare to all

We need to provide Medicare to all

By GEOFF THOMAS
Daily Record (Morris County, N.J.)
January 24, 2010

I am a health care reform activist, yet I cannot support the current health care finance reform bills moving through Congress. The current bills provide no real long-term savings, continue to enrich the bloated and inefficient for-profit private health insurance industry, and fail to address the crippling economic burden that every American worker must carry versus all competitors abroad.

To those on the right who say we cannot have a national health plan, I ask: Why must American companies continue to support the bloated and inefficient private health insurance industry, while upstart competitors can shed these costs by stiffing workers with a cheap plan, and international competitors are covered by efficient, nonprofit national plans?

Unethical bosses have the edge today, and under these bills, responsible bosses get shafted.

The Republicans always claim to be in favor of states’ rights. So why aren’t they supporting enabling states to set up their own single-payer systems? Conservatives claim to be in favor of competition, so why do they oppose competitive bidding for national bulk purchases of pharmaceuticals? Why are these principles never applicable when they would benefit ordinary people?

To those on the left who insist that any bill is better than no bill, I say, “Wake up and smell the coffee.” With the new bill, the United States will continue to remain inefficient and uncompetitive — losing jobs overseas while not bringing corrective needed reforms to our health care system. We need a simple, efficient and humane system that is carefully audited to detect and eliminate fraud and waste. The public option will not achieve that goal. It’s not really even a step on a path toward that goal.

We need a national nonprofit system of providing access to health care, as every other industrialized nation already has. We need to eliminate the role of private, for-profit insurers in providing access to necessary medical care in the United States.

We need a system that provides care for the sick at no cost out of pocket. All of the other developed nations have achieved something at least very close to that goal.

Yet early on, the Democratic majority refused to discuss national single-payer solutions to our health care morass. Why? Because senators in thinly populated states were fed a mind-boggling amount of cash by health industry backers to scuttle real reform.

I urge our public officials to educate themselves on the savings that HR 676, a national expanded Medicare system, would bring to New Jersey’s budget woes on all levels.

New Jersey could save $2.6 billion yearly under this bill, while erasing the unfunded and not often discussed current $58 billion health care liability already facing the state. This is a budget-busting, tax-bloating liability that will wreck New Jersey’s economy for years to come if not removed by HR 676.

Read more on health care finance reform at www.healthcare-now, and at www.PNHP.org.

Geoff Thomas is a resident of Madison.

http://www.dailyrecord.com/article/20100124/OPINION03/100123023/1096/OPINION/We+need+to+provide+Medicare+to+all

'Cadillac' health insurance is far from luxurious

By Suzanne Gordon
Salt Lake Tribune
Progressive Media Project
01/15/2010

I’ve had enough of the derisive talk about “Cadillac” health insurance plans. They’re not all that they are cracked up to be, and they are not what is driving health-care costs skyward.

My husband has been a union member and staffer for many years, and his employer provided my family (as a hard-won benefit of union negotiating) with what is now considered an unnecessarily “luxurious,” “wasteful” insurance vehicle.

So let me tell you how we’ve used our insurance plan over the past few years and how, in turn, it has misused us.

Three and a half years ago, I had an emergency appendectomy. During the surgery, I suffered several preventable complications, one that has proved to be quite serious. As a result, I needed extra visits to multiple doctors and physical therapists, as well as MRIs, ultrasounds and a variety of painkillers and other medications.

My husband was bitten by a feral dog in El Salvador and had to get 10 rabies shots when he got home.

Our daughter needed a variety of pills and shots before going to Rwanda to work for a group that helps women who were raped and infected with HIV/AIDS.

How have we fared when we’ve taken the Cadillac for a ride? Not well.

For more than 25 years, I was on the rolls as Suzanne Gordon, but then the insurer suddenly renamed me Suzanne Early (giving me my husband’s last name) when I submitted bills for my emergency appendectomy. Since there is no Suzanne Early (at least
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not one who’s actually me), it was no surprise that they couldn’t identify me as an enrollee. Claim denied. That took months to sort out.

When my husband got his rabies shots, the insurer denied the $1,000 claim because somehow the services weren’t coded as “medically necessary.” In his lengthy conversations with the insurer, he reminded them that since rabies is invariably fatal, dying of the disease would cost the company a heck of a lot more than $1,000.

No matter. To get the bill paid, it took a year of haggling, including receipt of many threatening letters from not just one but three bill collectors. And for months after the problem was resolved and the bill paid, we still were receiving dunning notices from one bill collector.

When my daughter needed more than the formulary-allotted supply of malaria pills (you can’t easily get them in Rwanda), it took dozens of calls to pharmacists, doctors’ offices and the union’s human relations department to get them and renew them.

Driving a Cadillac, it turns out, is almost a full-time job.

Like so much else in our health care debate — “death panels,” “socialized medicine” — the depiction of the so-called Cadillac option is a scare tactic meant to deceive and derail.

The tragedy is that in this instance, the scaremongers and derailers include President Obama, some of his party and too many of the progressive policy commentators.

Instead of blaming unions for bargaining for better (but still insufficient) health benefits for their members, we should be clear on who is really to blame for the real cost escalators in health care: a for-profit private insurance and a pharmaceutical industry that puts us all at risk.

Suzanne Gordon is the co-editor of the “Culture and Politics of Health Care Work” series at Cornell University Press. She wrote this for Progressive Media Project, a source of liberal commentary on domestic and international issues; it is affiliated with The Progressive magazine. Readers may write to the author at: Progressive Media Project, 409 East Main Street, Madison, Wis. 53703; e-mail: pmprojprogressive.org.

http://www.sltrib.com/opinion/ci_14202903

‘Cadillac’ health insurance is far from luxurious

By Suzanne Gordon
Salt Lake Tribune
Progressive Media Project
01/15/2010

I’ve had enough of the derisive talk about “Cadillac” health insurance plans. They’re not all that they are cracked up to be, and they are not what is driving health-care costs skyward.

My husband has been a union member and staffer for many years, and his employer provided my family (as a hard-won benefit of union negotiating) with what is now considered an unnecessarily “luxurious,” “wasteful” insurance vehicle.

So let me tell you how we’ve used our insurance plan over the past few years and how, in turn, it has misused us.

Three and a half years ago, I had an emergency appendectomy. During the surgery, I suffered several preventable complications, one that has proved to be quite serious. As a result, I needed extra visits to multiple doctors and physical therapists, as well as MRIs, ultrasounds and a variety of painkillers and other medications.

My husband was bitten by a feral dog in El Salvador and had to get 10 rabies shots when he got home.

Our daughter needed a variety of pills and shots before going to Rwanda to work for a group that helps women who were raped and infected with HIV/AIDS.

How have we fared when we’ve taken the Cadillac for a ride? Not well.

For more than 25 years, I was on the rolls as Suzanne Gordon, but then the insurer suddenly renamed me Suzanne Early (giving me my husband’s last name) when I submitted bills for my emergency appendectomy. Since there is no Suzanne Early (at least
Advertisement
not one who’s actually me), it was no surprise that they couldn’t identify me as an enrollee. Claim denied. That took months to sort out.

When my husband got his rabies shots, the insurer denied the $1,000 claim because somehow the services weren’t coded as “medically necessary.” In his lengthy conversations with the insurer, he reminded them that since rabies is invariably fatal, dying of the disease would cost the company a heck of a lot more than $1,000.

No matter. To get the bill paid, it took a year of haggling, including receipt of many threatening letters from not just one but three bill collectors. And for months after the problem was resolved and the bill paid, we still were receiving dunning notices from one bill collector.

When my daughter needed more than the formulary-allotted supply of malaria pills (you can’t easily get them in Rwanda), it took dozens of calls to pharmacists, doctors’ offices and the union’s human relations department to get them and renew them.

Driving a Cadillac, it turns out, is almost a full-time job.

Like so much else in our health care debate — “death panels,” “socialized medicine” — the depiction of the so-called Cadillac option is a scare tactic meant to deceive and derail.

The tragedy is that in this instance, the scaremongers and derailers include President Obama, some of his party and too many of the progressive policy commentators.

Instead of blaming unions for bargaining for better (but still insufficient) health benefits for their members, we should be clear on who is really to blame for the real cost escalators in health care: a for-profit private insurance and a pharmaceutical industry that puts us all at risk.

Suzanne Gordon is the co-editor of the “Culture and Politics of Health Care Work” series at Cornell University Press. She wrote this for Progressive Media Project, a source of liberal commentary on domestic and international issues; it is affiliated with The Progressive magazine. Readers may write to the author at: Progressive Media Project, 409 East Main Street, Madison, Wis. 53703; e-mail: pmprojprogressive.org.

http://www.sltrib.com/opinion/ci_14202903

Who Really Won in 2008?

By James Thindwa
In These Times
January 19, 2010

The voters who made Barack Obama’s historic election possible rightly expected far-reaching policy change. Yet what they have gotten is the same old corporate-driven politics.

Frustrated Obama supporters are told that the “machinery of Congress” grinds slowly; that only incremental change is possible; and that folks on “the left” are demanding too much and letting “the perfect be the enemy of the good.” Thus, we get a healthcare bill that rewards a predatory insurance system with millions of new customers—at taxpayer expense.

Apparently, it is paranoid to suspect that undue corporate influence might account for the rejection of demonstrably reliable governmental underwriting of healthcare. We are told the gradual degrading and then jettisoning of the public option and the proposed Medicare expansion—not to mention exclusion of single-payer from debate—is just a part of legislative deal-making.

But, delivering billions of taxpayer dollars to a monopolistic industry by forcing millions of people to purchase its product—with no option to join a public plan—is not inevitable. Nor is it good politics. How will Democrats defend forcing people to buy such tainted goods?

In recent weeks, some Democratic pundits have sought to silence the left. Instead of encouraging progressives to heed the example Obama himself once set as a community organizer, they countenance the sacrifice of core liberal principles such as reproductive rights, corporate accountability and inclusion of immigrants.

Writing in The New Republic, editor Jonathan Chait grumbled that progressives have an “irrational attachment to the public plan” and that criticism of Obama reflects the “bizarre convergence of left-wing and right-wing paranoia.”

Obama, in his September 9 address to Congress, also propagated this false parallel between left and right opponents when he decried the “unyielding ideological camps that offer no hope of compromise.” He even assigned motive to critics, saying they have “used this as an opportunity to score short-term political points.”

In other words, the President represents the “sensible center.” The left—those who demand a healthcare program that does not further enrich greedy insurance companies—are the extremists. The center is occupied by the likes of Sens Joe Lieberman (I-Conn.) and Ben Nelson (D-Neb.), who would hold hostage millions of uninsured in order to protect corporate profits. The center belongs to conservatives such as Rep. Bart Stupak (D-Mich.), whose obsession with abortion trumps any concern for the 45,000 people who die every year for lack of health insurance.

By reducing left-right differences on healthcare to merely “unyielding ideological camps,” the president and his defenders ignore the deep moral divide between progressives and conservatives. The left’s push for universal healthcare is grounded in the long-held principle of social justice, the same one that produced the New Deal, gave us Medicare in 1965 and ushered in a new era in civil rights.

Instead of dismissing progressives and apologizing for the President, Beltway liberals could have led the charge to dismantle the structurally conservative elements of our political system, from the undemocratic filibuster to the undue influence of corporate money in elections. Further, since progressives, liberals, the left—whatever we are calling ourselves—support universal healthcare, let us from now on, together, create a national echo chamber around “Medicare For All.” If this had been our collective mantra for the last 15 years, we would be in a better place today, and perhaps more unified.

James Thindwa is a member of In These Times’ Board of Directors and a labor and community activist.

http://inthesetimes.com/article/5430/who_really_won_in_2008/

UnitedHealth wields a machete

Insurer Steps Up Fight to Control Health Care Cost

By Anemona Hartocollis
The New York Times
January 24, 2010
A front in the national health care battle has opened in New York City, where a major hospital chain and one of the nation’s largest insurance companies are locked in a struggle over control of treatment and costs that could have broad ramifications for millions of people with private health insurance.
The fight is between Continuum Health Partners, a consortium of five New York hospitals, including Beth Israel Medical Center and St. Luke’s-Roosevelt Hospital Center, both major teaching hospitals, and UnitedHealthcare.
The prestigious hospitals and the major health insurer have been in bitter contract negotiations, not just over rates but also over UnitedHealthcare’s demand that the hospitals notify the insurance company within 24 hours after a patient’s admission. If a hospital failed to do so, UnitedHealthcare would cut its reimbursements for the patient by half.
UnitedHealthcare says the proposed rule is meant to improve the quality of care and cut costs by allowing insurance case managers to jump in right away. The hospitals say that having their reimbursement cut in half is too much to pay for a clerical error, and that the revenue drain would ultimately hurt their patients.
The dispute signals a “ratcheting up” of a long tradition of insurers trying to cut costs, said Jeffrey Rubin, an economics professor at Rutgers University.
http://www.nytimes.com/2010/01/25/health/policy/25insure.html?ref=health&pagewanted=all

The leadership of America’s Health Insurance Plans (AHIP) and Physicians for a National Health Program (PNHP) do agree on one crucial point: the current health care reform proposal does very little to control the intolerable escalation of health care costs. Both agree that Congress must provide the remedies to control spending and improve health care value.
What will occur without government action? Cost containment will remain in the hands of the private insurance industry. The tools at their disposal are very intrusive and are what resulted in the managed care backlash by unhappy patients and their providers. With the continuing increase in costs and the need to avoid pricing premiums totally out of the market, more intensive and extensive intrusions can be anticipated.
Look at this provision that UnitedHealth is demanding in its contract negotiations with a prominent New York hospital chain. If a hospital commits the clerical error of failing to notify UnitedHealth of a patient’s admission within the first 24 hours, the hospital is penalized 50 percent of its already reduced contracted rate! When the insurer is notified, they have the “insurance case managers jump in right away.” Although they claim that it is to improve quality, no sane person is deceived by the budget machete that they wield.
Without effective reform, it will get much worse since premium increases must be limited – they’re already too high – so insurers will be left with no alternative but to whack away at spending. Whacking spending means whacking patient care. Insurers really don’t want to do that. It is not for altruistic reasons, but it is rather the fear that their business model could suffer irreparable harm under the wrath of enraged patients and their health care providers (not that it hasn’t already).
It is no wonder that AHIP wants Congress to enact cost containment so the government becomes the bad guys. But do they really expect Congress to establish a government bureaucracy of machete-wielding case managers while the insurance industry gets a free ride? Yet that is the form of cost containment that fits with the model in which the private insurers retain control of the funds.
We’ll say it again. Private health insurance plans are an obsolete model of financing health care. Affordable premiums, adequate benefits, and affordable out-of-pocket costs are incompatible under the private insurance model because of the very high health care prices in the United States.
Methods of cost containment is where PNHP and AHIP part ways. PNHP recommends eliminating the obsolete private insurance industry and replacing it with a single payer national health program – an improved Medicare for everyone.
An improved Medicare for all would save hundreds of billions of dollars in wasted administrative excesses. Although some claim that this is a one-time benefit, it is a profound waste that never returns, providing savings every year thereafter. The system would be operated under a global budget, adjusted for demographics, inflation, and beneficial advances in technology, maintaining spending at a sustainable level. Hospitals would be funded through global budgets, eliminating the need for armies of clerks attempting to obtain reimbursement from a multitude of payers for each itemized expenditure of the hospital. Health professionals would negotiate compensation to meet their costs and provide fair profits. Bulk purchasing at negotiated rates would enable fair pricing for pharmaceuticals and medical supplies. Capital improvements would be separately budgeted to correct for both excessive and deficient supply side capacity, avoiding excess costs by improving efficiency.
The differences could not be more clear. Private insurers want government interventions to protect their businesses. Advocates of an improved Medicare for all want everyone to have the health care that they need, while making the health care system affordable for all – individuals, businesses, and the government and its taxpayers.

Americans need single-payer for all

Letter to the Editor
The Tennessean, Jan. 20, 2010

Jack Irby of Smyrna is to be applauded for his stand on the issue of health care for Americans as being a right and not a privilege.

He is on solid, rational ground when he concludes that the evidence is overwhelming that we must end the private insurance domination of health care in our country and move toward a publicly financed, single-payer Medicare for all approach.

Unfortunately, our Congress and the leadership in the White House “just don’t get it.” More likely, campaign financing dollars trump reason in America.

In either case, the meager progress so far made in the name of “reform” represents a shamefully disappointing effort.

James Hudson, M.D.
LYNNVILLE, Tenn.

http://www.tennessean.com/article/20100120/OPINION02/100119059/1008/OPINION01/Americans+need+single-payer+for+all

Obama should seize moment to push for Medicare for All, doctors group says

Dr. Quentin Young comments on Massachusetts election, next steps for health reform

FOR IMMEDIATE RELEASE     
Jan. 22, 2010   

Contact:
Mark Almberg, (312) 782-6006, cell: (312) 622-0996, mark@pnhp.org
Quentin Young, M.D., (312) 782-6006

A spokesman for a national physicians’ group says it would be a mistake for President Obama to conclude from Tuesday’s vote in Massachusetts that he needs to “tack more toward the right,” as some pundits have advised, or to aim for a scaled-back set of piecemeal reforms. Instead, the spokesman says, the president and Congress should immediately move to expand the popular Medicare program to cover everyone.

“President Obama and Congress should seize this moment to change course and re-inspire the U.S. public with a plan that is simple, clear, workable, fiscally responsible, comprehensive and truly universal  — namely, single-payer Medicare for All,” said Dr. Quentin Young, national coordinator of Physicians for a National Health Program.

Young dismissed suggestions by some that the House should adopt the Senate bill as it presently reads, send it to the president’s desk, and have Congress improve upon it later. “The Senate bill is rotten,” he said. “It’s a huge financial handout to the for-profit insurers and big drug companies. If passed, it will still leave at least 20 million uninsured and millions more unable to afford the care they need.

“Yesterday’s Supreme Court decision removing bans on corporate contributions in candidate elections will only make this fatally flawed bill even more difficult to improve upon,” he said. “It’s too laden with concession after concession to the private health industry to serve as a starting point.”

“Instead, we need to start anew and build on a system that we know works well, is cost-efficient and that could quickly be extended to cover everybody,” Young said. “That’s the Medicare program, which was implemented within one year of its enactment in 1965 and now covers about 45 million people, mainly seniors and the totally disabled.”

“Extending Medicare to cover the entire population would result in $400 billion savings annually by eliminating the administrative waste — the unnecessary paperwork and bureaucracy — inflicted on the U.S. economy by the private health insurers,” he said. “That would be enough to ensure high-quality coverage for everybody.”

Young said it would be a mistake to interpret the election of Republican Scott Brown to the late Sen. Edward Kennedy’s seat as a rejection by voters of fundamental health reform. Many independents and Democrats voted for Brown or stayed home because of mounting economic insecurity and their belief that the health reform process led by the Democrats had been corrupted by the big insurance and drug companies, he said. Union voters were especially angry with the proposed excise tax on workers’ health plans.

“It was more of a protest vote,” he said.

Young pointed to a 2008 ballot initiative in 10 legislative districts in Massachusetts, including one that overlaps with Brown’s state senatorial district, that asked voters if they support “legislation creating a cost-effective, single-payer health insurance system that is available to all residents, and oppose laws penalizing those who fail to obtain health insurance,” i.e. an individual mandate.

“Seventy-three percent of Massachusetts voters in these districts voted for a single-payer program and against the individual mandate, a hallmark of their own state’s plan,” Young said. “The Massachusetts plan is now in financial trouble. It’s fair to assume that those who voted this way in 2008, like many others in exit polls this week, believe the bills in Congress don’t go far enough toward real reform.”

“Nationwide,” he said, “polls show about two-thirds of the U.S. population would favor a Medicare-for-All approach, and a solid majority of physicians now support efforts to establish national health insurance.”

Young also pointed to the robust movement in several states, including California and Vermont, where physicians, among others, are pressing for single payer at the state level.

Nearly 1,000 health professional students and their allies rallied on the steps of the State Capitol in Sacramento, Calif., on Jan. 11, in support of S.B. 810, a single-payer bill that was reintroduced Thursday in the Legislature, he said. Similar bills were approved twice by California lawmakers in recent years, only to be vetoed by Gov. Arnold Schwarzenegger.

In Vermont, some 300 citizens bearing thousands of petition signatures flooded the chambers of the State Capitol in Montpelier on Jan. 12, calling for enactment of a similar proposal there. Many participants said the national bills were completely inadequate to address the state’s urgent health care needs, Young said.

A bold policy shift to single payer on the national level is more plausible than many people think, given the public’s support for such an approach, he said, and given the Medicare program’s “44-year track record of proven success.”

Whatever deficiencies the Medicare program presently has could be easily remedied in a streamlined, better-funded single-payer system, he said. “In fact, single-payer Medicare for All would yield enormous efficiencies and savings through measures like bulk buying and negotiated fees, benefiting everyone and making the program sustainable for future generations. It would also be a much-needed boon to our economy.”

“The president and Congress, if they truly stand up against the insurance and drug companies and press for single-payer Medicare for All, will find a public and a medical community ready and willing to support them,” he said.

*****

Physicians for a National Health Program (www.pnhp.org) is an organization of 17,000 doctors who advocate for single-payer national health insurance. To contact a physician-spokesperson near you, visit www.pnhp.org/stateactions  or call (312) 782-6006.

Insurers face consequences whether or not reform fails

If Bills Fail, a Quandary for Insurers

By Reed Abelson
The New York Times
January 21, 2010

With the possible collapse of the Congressional health care effort, health insurers might seem to have reason to celebrate. The legislation threatened to remake much of their business, with the prospect of burdensome government regulation and less profit from selling coverage to individuals and small businesses.

But now, in the possible absence of forced change to their business, the insurers still face the daunting challenge of selling a product that is increasingly out of reach for more Americans as the cost of medical care — and thus premiums — continues to climb.

Moreover, the industry’s main business of selling coverage through employers has largely stalled, while the weak economy has speeded the loss of customers as people lose their jobs and their health insurance.

“People are still being crowded out of the market because they can’t afford it,” said Sheryl R. Skolnick, a health care analyst for Pali Capital in New York.

But without the aid of the government through some provisions of the legislation, some policy analysts say the insurers might be hard pressed to rein in the fees charged by hospitals and doctors.

“They’ve lost all the leverage reform would have given them,” said Len Nichols, a health care economist for the New America Foundation, a policy research organization that supports an overhaul.

And the insurers say they know they cannot fix many of the problems in the health care system without the support of the government.

For insurers, the largest risk may be that without a government-led overhaul, their industry faces an even bleaker future should medical costs and premiums continue to soar, perhaps eventually prompting draconian changes from the government.

By the time Congress dares to try again to overhaul health care, some analysts predict, the problems with the system might be so acute that Washington might regulate the insurers more heavily than has been considered for the current legislation — or flirt even more with the idea of the federal government becoming directly involved in providing insurance.

“It’s going to come back to the forefront again,” predicted Matthew Borsch, an analyst at Goldman Sachs who follows the industry and says the insurers face an increasingly daunting environment.

http://www.nytimes.com/2010/01/22/health/policy/22insure.html?hp=&pagewanted=all

Comment: 

By Don McCanne, MD

We have stated repeatedly that health care costs are now so high that private insurers are no longer capable of providing health plans with affordable premiums if those plans are to be effective in preventing financial hardship in the face of medical need. Private health plans are an obsolete method of financing health care.

The health care reform process began with the goals of covering everyone and controlling health care costs. That would have been a straightforward task had they agreed to establish a single payer national health program. Instead it was decided to build reform on the foundation of our existing private insurance industry that is approaching obsolescence.

Keep in mind what health care now costs for our healthiest sector – the healthy workforce and their young healthy families. The average costs for a family of four is now $16,771 (Milliman Medical Index). This does not include insurer administrative costs. Considering that median household income is $50,303 (2008), the premium that must be charged for a private plan with adequate benefits, plus the out-of-pocket expenses, are totally out of reach for the average family.

The private insurance industry has survived to this point primarily for two reasons. Most important is that they have been able to sell their products to the healthiest of us – group plans for the healthy workforce, and individual plans for those who pass underwriting requirements. Also the tradition of employer sponsorship of plans has provided a revenue source that has been tolerated by workers who forgo their wage increases.

But the cost of these plans have reached a threshold such that employees are no longer tolerating stagnation of their wages, and employers are no longer tolerating the costs of their combined employee wage and benefit packages. Insurance plan innovations designed to slow the premium increases to keep them competitive have shifted costs to employees who actually need health care. The backlash against these unanticipated costs is sure to accelerate.

The insurance industry had no choice but to turn to the government for solutions that would ensure its survival. As Congress patched the reform proposal together, it became immediately obvious that the private insurance model was not capable of covering everyone, so they gave up on the goal of universal coverage. As they continued to work on the problem of high costs, the limitations of the private insurance model left them with wish-they-would-work policy options that would have very little impact on cost containment.

With abandonment of the two primary goals for reform, Congress was left with the job of patching together policies that would keep the insurance industry in play, as if protecting the private insurers was the primary goal in the first place. To greatly expand their market, the insurers would have to accept patients who actually needed health care, ending disqualification for preexisting disorders. To prevent adverse selection, everyone would be mandated to purchase health plans.

That would provide the plans with the market that they need, but it left one more problem. To make premiums affordable, even with subsidies, health care costs would have to be controlled. The insurers insist that the government must control the costs, but that does not work in a model designed to leave the private insurers in charge of health care financing.

If no reform is enacted, the entire insurance industry goes into the death spiral of ever higher premiums. If the Senate version is enacted, the insurers would get a temporary reprieve through the government subsidies, but it would not be long before rising costs would again be unbearable for the payers. The golden age of America’s private health insurance industry is about to end, whether or not a bill passes.

The Massachusetts election has given us a brief window in which we can step back and ponder, “What on earth are we doing!?” We can do it right. We can dismiss the obsolete model of private insurance plans and enact an equitably-financed, improved Medicare that really would include all of us, and provide an effective mechanism for slowing health care spending.

Consequences of the Privatized Funding of Medical Care and the Privatized Electoral Process

By Vicente Navarro, M.D.
American Journal of Public Health, Jan. 14, 2010 

The current state of health care reform in the United States reveals the enormous limitations of democracy in this country, unparalleled in the western world. Why is there such a large gap between what people want from their representatives in Congress – including universal access to health care as a matter of right – and what they get? 

To answer this question, we first need to look at what is happening in the U.S. medical care sector. I think it’s fair to say that what we see there is also unparalleled in the western world. Forty-seven million people are without any form of health insurance coverage (and a million more are added each year) and 102 million have insufficient coverage (and many aren’t aware of how limited their coverage is until they find out that an illness or needed test is not covered).1 The clearest indicator of the inhumane system of funding and organizing medical care in the United States is that 40 percent of people in the terminal stages of illness say they are worrying about how to pay their medical bills.2 No other major country comes even close to this level of inhumanity. 

The root of the problem is the privatization of the funding and organization of medical care. Most of the funds are collected and services administered by private insurance companies. This system is rooted in the Taft-Hartley Act (the same act that forbade the working class to act as a class, by forbidding sympathy strikes that would allow workers from different employment sectors to strike to defend their class interests). Taft-Hartley shifted the responsibility for working people’s health benefits coverage to highly decentralized collective bargaining agreements, which explains the great variability in coverage. One consequence is that when American workers lose their jobs, they lose not just income but health benefits for themselves and their families. It is not surprising that the United States has the fewest working days lost to strikes. Workers are afraid to make trouble in the workplace, because getting fired could mean losing medical care for their families.3 

It has been a traditional demand of the labor movement to get rid of the consequences of the Taft-Hartley Act. The demand for universality of health care, with every American having the right to access care, has been a constant in the labor and progressive movements. The majority of Americans agree with this demand, but they are unlikely to get it.4 

The reason for this gap between what people want and what people get is, again, privatization – a privatized electoral process, in which most campaign funding of candidates for political office comes from private sources. That private money does not mainly come (as myth would have it) from multitudes of average Americans sending in $50. The great majority comes from huge economic interests (components of the “Corporate Class”), including the insurance, pharmaceutical, and medical equipment companies; the professional associations; and other components of the medical-industrial complex. The six key members of the Senate Finance Committee, chaired by Sen. Max Baucus (D-Mont.), have received support from these interests. They received a million dollars each.5 

To further compound the problem created by a privatized electoral process, U.S. democracy is a nonproportional type of democracy— that is, the population is not represented in Congress in proportion to the size of the electorate. Each state is represented by two senators, regardless of its size, which gives enormous power (as the country’s founders intended) to rural, conservative states. The six key senators on the Finance Committee represent rural states that, in sum, include only about 3 percent of the U.S. population, and these senators have the future of health care reform in their hands. 

Democracy in the United States is indeed extremely limited. The opening of the nation’s founding document, the U.S. Constitution, suggests that it is “We the People . . .” who make decisions, but it should include a footnote saying “or Corporate America.” Furthermore, those who do decide are not fully representative of the population. Still, the United States is not a dictatorship, but a democracy so tilted in favor of corporate and conservative interests that an enormous effort is required to create change. The election of President Obama seemed to be such a change and a sign of hope, because this was the trademark of his campaign. But since coming into office, he seems to have been poorly advised on his strategy for implementing the promised change. He has made several big mistakes. 

OBAMA’S MISTAKES 

1. An emphasis on the issue of economic viability of the system, stressing that medical expenditures (private and public) are increasing too rapidly and enlarging the federal deficit. This message has been repeated in many different ways, emphasizing that a primary goal of health care reform is to reduce the federal deficit. Most of the reforms the administration is calling for (which will, undoubtedly, cost money) will be funded by increasing the efficiency of the current public and private programs. People’s well-founded skepticism about Congress explains why so many (including Medicare beneficiaries) have expressed their concern about the meaning of “increasing the efficiency,” which they interpret to mean reducing their benefits. It is not surprising that the major opposition to the Obama reform proposal comes from the beneficiaries of these public programs, especially Medicare. 

2. The concern about costs and the need to improve efficiency expressed together with an emphasis on covering the uncovered as a moral problem that needs to be resolved. This is indeed a moral issue. But, when Obama adds that he plans to pay for this expansion of coverage by increasing the efficiency of current programs, he is calling on people’s compassion, with the possibility of most people (who do have coverage) seeing their benefits reduced to take care of the uncovered. We have plenty of experience (with antipoverty and other means-tested programs) to show that compassion is not a good motivator. Solidarity (I take care of you on the condition that you take care of me) is a much better motivator. 

What Obama should have done is expand and improve the Medicare Program to all Americans. This would resolve the problems of the uncovered and of everyone else. The call for a universalism mandated by government (not a mandate that individuals must buy their own health insurance, just as they have to buy car insurance) is far more ambitious (and more realistic) than a gradual path to universalism, which is likely to fail. 

3. Antagonizing the left. Achieving a universal right to health care requires a huge mobilization, comparable to that which got Obama elected. For this the president needs the left. Obama could not win only by mobilizing the left, but he could not win without it. He has antagonized the left by excluding single-payer health care from the negotiating table. I can understand why he changed his mind and decided not to support the single-payer option, but I cannot understand (because it was a tactical error) why, after saying that all options would be included, he excluded the single-payer option – the alternative preferred by the trade unions, the major social movements (such as the civil rights, feminist, and green movements), and others who were the core of his support and are the grassroots of the Democratic Party. To make things worse, he is ready to eliminate even the public option, which is seen as a way of introducing the single-payer option through the backdoor. So, it is not surprising that the left is feeling frustrated, angry, and
demoralized (and did not show up at the town hall meetings). 

All of this reminds me of what I saw during and after my time on the Clinton White House health care reform task force (as the “token single-payer expert”). Clinton had won the election of 1992 with a commitment to provide universal coverage. But once in office, he gave priority to reducing the federal deficit (not even in his campaign program), under pressure from Wall Street through Treasury Secretary Robert Rubin, and to approving the North American Free Trade Agreement, which was opposed by the trade unions and the majority of the Democratic Party. This antagonized the left of the party, and large numbers of Democratic voters stayed home in the 1994 congressional elections. The “Gingrich Revolution” was a consequence of this abstention of the Democratic grassroots. The Republicans received about the same number of votes in 1994 as in 1990 (the preceding nonpresidential election year). There was no increase in the Republican vote, but rather a decline in the Democratic vote. I am afraid that the same could happen in 2010. 

Vicente Navarro is with Johns Hopkins University, Baltimore, Md. Correspondence should be sent to Vicente Navarro, M.D., Ph.D., Professor of Health Policy, The Johns Hopkins University, 624 N. Broadway, Rm 448, Baltimore, MD 21205 (e-mail: vnavarro@jhsph.edu). 

This article was accepted November 11, 2009. doi: 10.2105/AJPH.2009.187633 

References

1. Hellander I. The deepening crisis in U.S. health care: a review of data, Spring 2008. Int J Health Serv. 2008;38(4): 607–623. 

2. Ann Intern Med. 2000; :132– 145. 

3. Navarro V. Dangerous to Your Health. Capitalism in Health Care. New York, NY: Monthly Review Press; 1993. 

4. Washington Post/ABC News. 2008. 

5. Kaiser RG. So Damn Much Money: The Triumph of Lobbying and the Corrosion of American Government. New York, NY: A Knopf; 2009. 

http://ajph.aphapublications.org/cgi/content/abstract/AJPH.2009.187641v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=waitzkin&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

Whistleblower reveals how insurers can game healthcare bill

By Brad Jacobson
The Raw Story
Wednesday, January 20th, 2010

Though Senate bill cuts ‘pre-existing conditions,’ it still allows insurance companies to create ‘pre-existing’ categories to raise rates

The Democrats’ healthcare overhaul, billed as a monumental game-changer for Americans’ health insurance coverage, provides numerous loopholes for health insurance companies which will allow them to raise rates to protect profit margins, a health insurance whistleblower says.

Wendell Potter, a twenty-year veteran of the insurance industry and former vice president of communications for Cigna, warns that current healthcare legislation does nothing to prevent the insurance industry from continuing its ongoing practice of increasingly shifting healthcare costs to consumers.

A form of bait-and-switch, such practices often set up individuals, families and small businesses for inadequate or unaffordable access and a continued looming threat of financial ruin. The overlooked element, Potter says, is that insurance companies will be able to claim they are reducing premiums by forcing more Americans to pay higher deductibles and offering less coverage.

“We talk a lot about affordability, and we talk about affordability of insurance premiums,” Potter told Raw Story in a nearly hour-long interview. “But when you talk about affordability, you need to talk about affordability of premiums plus out-of-pocket expenses.”

He said that there’s been a lot of discussion on how the Congressional Budget Office scored this legislation and what it says this legislation will cost the country in the long run, but little to no focus on how the legislation will directly impact individual Americans.

Potter pointed out, for example, that many plans — even after consumers received proposed government subsidies to help pay for them — would come with high deductibles that prohibit people from using their insurance or cause them the kind of financial hardships that healthcare reform was purported to prevent.

“What worries me,” he said, “is people who are forced to buy coverage and all they can afford to buy is a high deductible. And if they get really sick then they have to pay so much out of their own pockets that they’re going to be filing for bankruptcy and losing their homes.”

In the Senate bill, in particular, Potter noted, some people will be buying insurance that will only cover roughly 60 percent of their medical costs if they get sick.

“There are a lot of people who don’t have insurance now because they can’t afford premiums,” he said. “They certainly couldn’t afford premiums plus the out-of-pocket expenses in today’s market.”

Potter asserted that the current legislation will, in large part, simply move millions of people from being uninsured to underinsured, or from insured to underinsured. Citing a 2007 study by the Commonwealth Fund, he said there are already over 25 million Americans who fall into the category of the underinsured.

Potter also noted the deleterious effect of cost shifting on small businesses. Many small business owners will earn just enough to be denied subsidies.

“After a certain income level, there are no subsidies,” Potter explained. “But you still have to buy coverage. And I’m concerned that after you get above the median level of income, you’ll find that a lot of people who don’t get subsidies will probably be forced to buy coverage. But the only coverage they’ll be able to buy will make them underinsured.”

There’s also no prohibition in the legislation against insurance companies moving more and more people into high-deductible plans. Such plans, Potter argued, will help insurers’ bottom lines because fewer policyholders will actually avail themselves of their insurance.

“When you have a benefit plan that requires people to pay a lot out of their own pocket, a lot of these people will never get to the point of using their insurance because they won’t go to the doctor or pick up their medicines to satisfy the deductible,” Potter told Raw Story.

“I see nothing in this legislation that essentially would protect people from losing their homes or filing for bankruptcy,” he added.

How insurance companies can still game the system

While prohibitions on such practices as denying healthcare to people with pre-existing conditions remain in the legislation, Potter noted that the Senate bill, in particular, provides the insurance companies with “all the flexibility they need” to more than make up for any profits lost due to new reform measures and to prevent people from accessing coverage.

He pointed out, for example, that “health factors” such as chronic diseases and age would continue to play into how much individuals can be charged in premiums and how many of them may be forced into high deductible plans.

“What they will be doing, what they can in the Senate bill, is charge people significantly more if they have certain health factors,” Potter said. “And it would be pretty much up to the industry to decide what those health factors are. You could have high blood pressure, high cholesterol, diabetes. You could be overweight, have a history of tobacco use. There definitely would be a wide range of things that the insurance industry would be able to look at and determine whether or not to charge you more.”

He also noted that the Senate bill would allow insurance companies to charge people who are older up to three times as much as those who are younger and, in the House bill, two times more than a younger person.

“And of course when people get older they develop more health factors,” Potter said. “So that is another way to get around the loss of revenue. Plus, of course, they would be able to get new revenue coming in from people who are younger and don’t have health factors that they charge more for.”

Moreover, he said, “They still would be getting a new revenue stream from people who are younger. So they’ll be getting significantly more in revenue. And those people are quite profitable too because they don’t file many claims.”

To justify this practice, Potter explained, insurers would claim that they’re providing lowered or discounted premiums to healthier people. But, in reality, premiums across the board are set so high that healthier people wouldn’t actually be receiving anything that could be considered a discount.

“Healthier people would be paying pretty much a standard rate at the end of the day,” said Potter, while the chronically ill and the aged would be paying exceptionally more on top of the already pricey standard rate.

Medical-loss ratio

The former insurance executive also says another element of the healthcare overhaul is receiving too little attention: the medical-loss ratio, which determines what percentage of health insurance premiums are spent on actual medical costs. The difference of just a few percentage points can mean billions of dollars to the insurance industry.

“We’re talking about big-time money here,” said Potter. “The insurance industry doesn’t want to have any restrictions on the medical-loss ratio. So they’ll be doing all they can to keep it from being enacted if possible.”

Some members of Congress, led by Sen. Al Franken (D-MN), proposed an amendment to require that 90 percent of consumer premiums go to medical costs, but Potter doesn’t think that’s likely to happen and said insurers will fight tooth-and-nail to set any minimum as low as possible. The Congressional Budget Office said that the 90 percent figure was too high and would basically drive insurers out of business, recommending 80-85 percent instead. Democrats are expected to embrace the
lower figures in their final bill.

Potter cautioned that legislators need to keep an eye on how insurance companies define medical and administrative expenses. And he said that legislation should require companies to explain what they’re spending money on and what percentage in dollar amounts they’re spending.

“You can set the medical-loss ratio, but you need to make sure that it’s clearly understood what the components of the administrative expenses are,” Potter explained. “Because they can shift stuff around from one bucket to another and claim that what they’re actually spending is beneficial to the patient when it may not be.”

For example, he said they can easily meet an 85% standard if the definition enables them to categorize such items as disease management programs as paying for medical care. Currently, money spent on disease management programs is counted toward administrative costs.

Potter also noted that insurance companies have kept the issue of the medical-loss ratio — something little understood by the American public — “pretty much just a conversation between them, their shareholders and the analysts who cover them. They don’t talk about it anywhere else.”

Potter raised this complex but critical issue during his Senate testimony in June.

“Every decimal point makes a big difference,” he added. “We’re talking in the billions.”

http://rawstory.com/2010/01/whisteblower-reveals-health-insurers-game-insurance-bill/

What Massachusetts Got Right

By Robert Scheer
TruthDig, Jan 20, 2010

The president got creamed in Massachusetts. No amount of blaming this disastrous outcome on the weaknesses of the local Democratic candidate or her Republican opponent’s strengths can gainsay that fact. Obama’s opportunistic search for win-win solutions to our health care concerns and our larger economic problems is leading to a lose-lose outcome for the president and the country.

The two issues that mattered on Election Day were the economy, which Obama has sold out to Wall Street—as quite a few disgruntled voters pointed out—and his plea to save health care reform, which the voters who had backed him for the presidency with a huge majority now spurned. It is significant that it was the voters of Massachusetts who have now derailed the Democrats’ efforts to revamp the country’s health care system by denying them the necessary 60th vote in the Senate, for these voters know the subject well.

The federal proposal is based on their own state’s model requiring people to obtain health insurance without the state doing anything to effectively control costs through an alternative to the private insurance corporations. Lacking a public option, the cost of health care in Massachusetts, already the highest in the nation at the time of the plan’s implementation, has spiraled upward. Services have been curtailed, and many, particularly younger people, feel they are being forced to sacrifice to pay for a system that doesn’t work.

Instead of blindly following the failed Massachusetts model, Obama should have insisted on an extension of the Medicare program to all who are willing to pay for it. He squandered the opportunity to bring about meaningful health care change that the public would have supported had it been kept simple and just. Instead, Obama gave away the store to medical profiteers. They, in turn, hopelessly muddied the waters with well-funded scare advertising tactics that principled leadership on Obama’s part could have thwarted.

A mere seven months ago, The New York Times/CBS poll found that 72% of Americans “supported a government-administered insurance plan—something like Medicare for those under 65—that would compete for customers with private insurers.” Even half of those identified as Republican said they would back such a public plan, as would three out of four independents and 90% of Democrats. Instead of heeding that call by endorsing a serious extension of Medicare, along with increased subsidies for those who could not afford it, Obama played to the conservatives in Congress—and they rolled him.

If he wasn’t prepared to make a breakthrough in health care, and that meant a reform program that would begin sooner rather than later, he should have put it on a back burner. The furor over a very unsatisfactory plan drew attention from the far bigger crisis concerning the meltdown of the nation’s economy. By accepting and indeed expanding the Bush administration’s strategy of throwing money at Wall Street, Obama ceded the populist label to the Tea Party Republicans who now pretend that a banking mess brought about by their radical deregulatory philosophy is not of their making.

It is the economy, stupid, and the sooner Obama grasps that, the better for his and the nation’s prospects. A new Wall Street Journal/NBC poll finds that “Americans ranked job creation and economic growth as their clear top priority for the federal government, well above national security and deficit reduction. Health care, Mr. Obama’s top domestic priority in 2009, now ranks fourth, closely trailing the deficit and government spending.”

Of course, the public is right. In the midst of the worst economic crisis in 70 years, why waste enormous political capital battling to pass a health care plan that is modeled on a proven failure in Massachusetts, as voters there clearly registered? Meanwhile, the president has dropped the ball in the effort to make bankers act responsibly by forcing them to forego outrageous bonuses and help homeowners stay in their homes.

Again quoting the message of that Wall Street Journal/NBC poll: “The president’s focus on health care amid heightened job concerns could be hurting his ratings. At the one-year mark of his presidency, 35% of Americans said they were ‘quite’ or extremely’ confident he had the right priorities to improve the economy, down from 46% at midyear.” The Journal noted that a majority disapproved of the government’s response to the financial crisis, adding, “The related problem for Mr. Obama is the public’s lingering anger about the bailouts of 2008 and 2009, which helped boost bank profits even as unemployment grew—a toxic political problem.”

To salvage his presidency, Obama must reverse course and make solving the “toxic political problem” of Wall Street greed that’s bankrupting the country his highest priority. 

http://www.truthdig.com/report/item/what_massachusetts_got_right_20100120/

Anger over Health Care Bill Creates Uncertain Future

By Jane Slaughter
Labor Notes, January 20, 2010

A Massachusetts local union president called it before the January 19 vote for senator: Ive never seen this much anger at the Democrats from union people, said Jeff Crosby, president of a General Electric factory local near Boston, as he prepared a last-minute leaflet to hand out in the plant. Its worse than NAFTA.

Top union leaders had bargained a compromise [1] slowing down the health care benefits tax President Obama insisted on, but it was not enough to placate union membersand othersinfuriated that Obama had broken his campaign promise not to tax benefits.

Crosby said his members were threatening to vote Republican to stop the tax, since 60 Democratic senators and no Republicans had voted for it. In Massachusettsspecial election they chose empty-suit Republican Scott Brown over a Democrat bound to cement the benefits tax in place.

In a Suffolk University poll conducted a week before the election, union-household voters in Massachusetts reported only 45 percent support for the Democratic candidate; union voters nationally backed Obama by 60 percent in 2008.

According to those on a January 14 conference call with AFL-CIO President Rich Trumka, Massachusetts state fed President Bobby Haynes exploded in anger, blaming top union leaders for a terrible health care bill and for losing the Massachusetts electionand thus the Dems60th Senate seat, needed to ensure the health care bills passage (and the rest of labors agenda, labor law and immigration reform).

Obama took a hands-off approach to the content of the bill as it crept through Congress. He didnt insist on a public option nor a strong employer mandate to provide insurance. It was hard not to notice that the only issue on which he took a hard stand was taxing benefits.

At his meeting with a dozen labor leaders at the White House January 11, Obama was firm that a tax on benefits was a must-havedespite his campaign promise to the contrary. We have a lot of video clips,said Machinists President Thomas Buffenbarger.

Although the benefits tax was not the only issue on Massachusetts votersminds (the faltering economy was the No. 1 concern in the Suffolk poll), it was one of the clearest examples of the Obama administrations tilt away from working class voters, beginning with the bank bailout.

Trumka too had predicted that the health care mess would backfire on Democrats. In a January 11 speech [2] at the National Press Club, he said, In 1992, workers voted for Democrats who promised action on jobs, who talked about reining in corporate greed, and who promised health care reform. Instead, we got NAFTA, an emboldened Wall Streetand not much more. [In 1994] there was no way to persuade enough working Americans to go to the polls when they couldn’t tell the difference between the two parties.

NAFTA, which dealt a heavy blow to U.S. manufacturing, was voted up by Congress in 1993 after intense cajoling by President Clinton, garnering the votes of 102 House Democrats. Clinton lost the Democratic majority in Congress the next yearand never got it back.

LETS MAKE A DEAL

As the likely House-Senate compromise took shape in early January, it appeared certain that if the bill passed, people with good (or just expensive) benefits would face a steep 40 percent tax likely to push them into inferior plans.

So labor leaders reached a deal [3] with White House negotiators January 14 that accepted the tax theyd previously declared unacceptable. The deal announced by Trumka and his counterparts at Change to Win and the National Education Association would have exempted those in union-negotiated plans and state and local employees from the tax until 2018.

It also would have raised the threshold at which the tax kicked in for many other plans: those containing significant numbers of women, older workers, or retirees age 55 and up, or those in high-cost states, the latter affecting more than 38 million workers. Those provisions would have delayed those groupshit as well.

Trumkas goal was to exempt as many people as possible, union and non-union, from ever paying the tax, though only the velocity of health care cost inflation would have proved how successful he was.

Most of the 31 million insured employees who would be hit by the excise tax are not union members,Trumka noted before the deal was struck. But in the end unions bought extra time for their members at the cost of making themselves look self-interested. The deal will create awkward moments for union health care activists whove spent years trying to build broad coalitions.

STILL OPPOSED

Not all top union leaders backed the compromise plan. Buffenbarger told Labor Notes his members at Boeing, Lockheed Martin, and General Dynamics were already over the $23,000 threshold at which the tax would originally kick in.

No bill is better than this bill,Buffenbarger said. We don’t care what the amount is that they peg it to: because of inflation, whatever number will be gobbled up pretty quickly.

Firefighters President Harold Schaitberger said his union didnt ask for the bills special, higher threshold for first responders, $26,000 rather than $23,000. The provision was worthless, he said, because most of his members are pooled in larger municipal plans, with no mechanism to segregate them out. Were not going to buy into a special deal for us,Schaitberger said.

The SteelworkersLeo Gerard backed the compromise, telling Labor Notes he was thinking about Senator Jim DeMint, that right-wing nut from one of the Carolinas,whos said he wants to make health care Obamas Waterloo.

We have to do everything to make sure we get a good bill so we can move forward with the rest of the presidents agenda as quickly as possible,Gerard said.

Insiders say Trumka sold his compromise by arguing that health care reform had to get done so Congress could tackle long-delayed labor law reformthe Employee Free Choice Act.

Labors weakness throughout the health care reform process put a question mark over EFCA anyway, and even the question mark lay in tatters after the Massachusetts election.

Buffenbargerwho backed Hillary Clinton in the primarieswas a pessimist in any case. Were not going to get EFCA anyway,he said. Its an election year. No way theyre going to touch it.

TURN TO THE STATES

One bright spot could emerge from this winters health care debacle: union members not pushed into the arms of the tea-partiers could become convinced that Medicare for Allis the only solution.

It may mean more people are apt to be engaged on single payer because theyre getting hit themselves,said Lenny Potash, a retired AFSCME member and co-chair of the Labor Taskforce for Universal Healthcare [4] in Los Angeles.

Activists in California and Vermont have already begun serious work on state single-payer efforts.

The Vermont Workers Center [5] turned out 350 people to legislative hearings January 12 to testify for the states single-payer bill. Senator Bernie Sanders was followed by union nurses.

The center, the states Jobs with Justice affiliate, began organizing in earnest last year: a rally of 1,000 at the State Capitol on a work day; organized committees in every county; a dozen regional hearin
gs. The result, says co-chair Traven Leyshon, is that we have changed whats politically possible. As recently as September the legislature said they couldn’t be bothered with single payer.

All Democratic candidates for governor next fall say they support single payer (though Leyshon recalls former Governor Howard Dean, who was always for single payer till the day he became governor). The Democrats and the Progressive Party together have a veto-proof two-thirds majority in both houses.

A new single-payer bill, just introduced by a Progressive legislator, includes a just transition for insurance company workers and others who would lose their jobs under a single-payer system. The legislation was written so as to survive legal challenges.

SINGLE PAYER IN ONE STATE

California activists will back a single-payer bill starting this month, though Governor Arnold Schwarzenegger, whos in his last year, is certain to veto it for the third time (similar bills passed in 2006 and 2008). The campaign kicked off January 11 with 1,000 members of the California Health Professional Student Alliance and others rallying in Sacramento.

Michael Lighty of the California Nurses Association [6] explained that winning single payer is a multi-year project: heavy education this year, electing a Democratic governor who wont veto single payer this fall, passing a new bill, taking the measure to the voters in a referendum. The media campaign alone could cost as much as $20 million.

What about the cost, in a state thats broke? Cate Engel of the Labor Taskforce for Universal Healthcare said the bill ultimately would save California billions of dollars, by reducing administrative costs and using the states mammoth purchasing power to force drug and equipment prices down.

What about California unions that havent backed single payeror ditched the idea before the fight even began, citing political viability? Well, said Lighty, we saw what happened on the national level when they went for public option over single payer because of viability.

Bill Bryce is the Jobs with Justice organizer in Detroit. Hes shaking his head over the lost opportunities of 2009the year when Obama rode in on a wave of hope for change and corporations were in disgrace because of the financial fiasco.

Youre the president, you appear on TV and say, I have a suggestion, lets tax Wall Street bonuses at 50 percent and defray the cost of health care,’Bryce said. If this was not the time to take on the insurance companies and the banks, just when will that time come?

Source URL: http://www.labornotes.org/2010/01/anger-over-health-care-bill-creates-uncertain-future
Links:
[1] http://blog.aflcio.org/2010/01/14/health-care-tax-union-leaders-outline-big-improvements-for-all-working-families
[2] http://www.aflcio.org/mediacenter/prsptm/sp01112010.cfm
[3] http://www.labornotes.org/blogs/2010/01/victory-or-pretzel
[4] http://laborforsinglepayer.com
[5] http://www.workerscenter.org
[6] http://www.calnurses.org

http://labornotes.org/2010/01/anger-over-health-care-bill-creates-uncertain-future